EP1790298A1 - Système de guidage pour instrument chirurgical - Google Patents

Système de guidage pour instrument chirurgical Download PDF

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Publication number
EP1790298A1
EP1790298A1 EP06123897A EP06123897A EP1790298A1 EP 1790298 A1 EP1790298 A1 EP 1790298A1 EP 06123897 A EP06123897 A EP 06123897A EP 06123897 A EP06123897 A EP 06123897A EP 1790298 A1 EP1790298 A1 EP 1790298A1
Authority
EP
European Patent Office
Prior art keywords
shaft
guide
instrument according
implant body
stop
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP06123897A
Other languages
German (de)
English (en)
Inventor
Kay Fischer
Robert Schultz
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Aesculap AG
Original Assignee
Aesculap AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Aesculap AG filed Critical Aesculap AG
Publication of EP1790298A1 publication Critical patent/EP1790298A1/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684—Trial or dummy prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • A61F2002/30616—Sets comprising a plurality of prosthetic parts of different sizes or orientations
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/914—Toolkit for installing or removing spinal positioner or stabilizer

Definitions

  • the present invention relates to a surgical guide instrument for a surgical machining instrument, in particular a chisel with an implant body for insertion into an intervertebral space between adjacent vertebral bodies of a human or animal spine, with a shaft and with a stop device for limiting an insertion depth of the implant body in the intervertebral space the shaft has a distal end and a proximal end, wherein the implant body defines two contact surfaces which can be applied to the adjacent vertebral bodies and is arranged at the distal end of the shaft, the abutment device having at least one stop movably mounted on the distal end of the shaft or on the implant body Transversely or substantially transversely to at least one of the contact surfaces in the distal direction facing stop surface has.
  • intervertebral discs which connect adjacent vertebral bodies of the spine in an articulated manner.
  • intervertebral implants can rigidly connect adjacent vertebral bodies or even articulated, depending on the structure of the intervertebral implant.
  • intervertebral implants are often provided with projecting from abutment surfaces, which are designed to bear against adjacent to the intervertebral space vertebral bodies, protruding fin-like projections, which prevent a relative movement between the intervertebral implant and the vertebral bodies in which they rest.
  • grooves are incorporated prior to insertion of the intervertebral implant to the vertebral bodies, for example, milled or hammered with a chisel into which the fin-like projections of the intervertebral implant can dive.
  • the machining tool for example a chisel or a milling tool
  • instruments which have a stop which prevents the guide instrument from being inserted too far into the disc space so that an insertion depth of a machining tool is limited by the stopper of the instrument.
  • the stop devices of known instruments are arranged directly on a distal end of the instrument and can only be adjusted prior to insertion of the implant body of the guide instrument into the intervertebral space.
  • the guide instrument To vary a depth of impact or depth of insertion of the surgical machining tool, the guide instrument must be removed from the patient's body each time. Or it must be created such a large access to the body, which allows to adjust the stop device. Minimally invasive surgery would be virtually impossible.
  • the stop device at the proximal end or in the region of the proximal end of the Shaft disposed actuator and a shaft mounted on the power transmission member comprises and that the actuator, the power transmission member and the at least one stop are arranged and cooperatively configured such that by actuation of the actuator, the at least one stop in the poximal and / or distal direction is movable.
  • the development according to the invention has the advantage that the preparation of the vertebral bodies is considerably simplified before the insertion of an intervertebral implant with fin-like projections.
  • the guiding instrument can be inserted through a minimally invasive approach and, after insertion, the abutment can be actuated by the actuator from outside the human or animal body to adjust the abutment.
  • a maximum insertion depth of a surgical machining tool can thus be changed as desired.
  • this can be done under X-ray control, so that it can be ensured that when editing the vertebral body adjacent to the intervertebral space only as much is removed from the respective vertebral body as is actually required to insert the intervertebral implant. Furthermore, it is thus avoided that, when preparing the vertebral bodies, the machining tool can reach or enter the spinal canal and lead to injuries.
  • the actuator with the power transmission member is releasably connectable. This makes it possible to disassemble the management instrument also for cleaning purposes. Furthermore, as well as the actuator can be removed and replaced for example by another instrument.
  • a coupling device for connecting the force transmission member to the actuating member when a first and a second clutch member engageable with this coupling member are provided when the first coupling member is arranged on the actuating member and when the second coupling member on the force transmission member is arranged.
  • the one of the two coupling members is a predominantlyvielkant or a participatvielrund and if the other of the two coupling members is a corresponding inner polygon or a réellevielrund.
  • This allows a positive and / or non-positive connection between the actuator and the power transmission member, so that due to movement of the actuator, a corresponding movement of the power transmission member can be achieved safely.
  • the force transmission member may be slidably and / or rotatably mounted on the shaft.
  • a handle part is provided at the proximal end of the shaft.
  • the grip part is detachably connectable to the shaft.
  • the handle part if it is not needed, for example, when the implant body is introduced in the desired manner in the intervertebral space, can be removed so as not to interfere in the surgical field.
  • this also has the advantage that a handle for different Shafts can be provided. This means that, for example, only a single grip part is required in an operating theater and that a set of different shanks with different implant bodies can be provided so that individually different guidance instruments can be selected depending on the size of the intervertebral implant to be inserted.
  • the shaft can be connected in a particularly simple manner to the gripping part if a connecting device is provided for connecting the shaft to the gripping part if a first and a second connecting link which can be engaged with it in a connecting position are provided when the first connecting link is arranged on the shaft and when the second link is located on the handle portion.
  • a positive and / or non-positive connection between the shaft and the handle part can be achieved if one of the two connecting links is an outer polygon or an outer multi-wall and if the other of the two connecting links is a corresponding polygonal socket or an inner polygon.
  • the outer polyhedron forms a short shaft section of the shaft and if the inner polyhedron is arranged on the grip part. This makes it possible for the shaft to be partially inserted, for example with its proximal end, into the grip part.
  • the inner polygon therefore forms a shank receiving the outer polygon.
  • the connecting device is designed in the form of a latching connection, if the two connecting links in the form of in a latching position engaging latching members are formed and when the two latching members are arranged such that they are relatively movable in the transition from the detent position to a release position in which they are disengaged, and vice versa.
  • the shaft and the handle part can be plugged together in a simple manner. To release the locking connection only the two engaging in the locking position locking members must be moved relative to each other so that they get out of engagement. Then, the shaft and the handle part can be moved relative to each other and separated from each other.
  • one of the latching members is designed in the form of a latching recess arranged on the shaft and if the other latching member is a spring-biased latching pawl mounted on the handle part.
  • the two locking members can also be arranged vice versa on the shaft or on the handle part.
  • the proposed design has the advantage that the shaft is particularly simple in design and is particularly easy to manufacture, so that in particular only one handle part for different shafts must be provided, which can significantly reduce costs in the production of a set of different management tools.
  • the detent pawl is movably mounted in a direction transverse to the longitudinal axis of the shank. For example, forces acting on the guide instrument in the direction of the longitudinal axis of the shaft can not cause the grip part to detach from the shaft.
  • the actuating member In principle, it would be conceivable to arrange the actuating member on the shaft. In a set of different guide instruments would then be provided on each shaft and an actuator. Therefore, it is advantageous when the actuator is arranged on the handle part. This eliminates the need to provide an actuator on each shaft. If the grip part can be detached from the shaft, then the actuating member can also be released from the shaft and the force transmission member.
  • the force transmission member is slidably mounted in the direction of the longitudinal axis of the shaft at this. It is advantageous if the force transmission member is a shaft rotatably mounted on the drive shaft. This prevents movement of the power transmission member and the shaft relative to each other in the direction of the longitudinal axis.
  • the rotatably mounted drive shaft to be offset by the actuator in rotation and to move the at least one stop directly or indirectly.
  • the actuator as a parallel to the longitudinal axis of the shaft sliding push and pull member. It is particularly favorable, however, if the actuating member is a drive wheel rotatably mounted about a longitudinal axis of the shaft. As a result, it can be connected in a simple manner to a power transmission element mounted rotatably on the shaft. In addition, it can be operated in a particularly simple and ergonomic manner, since no forces acting in the direction of the longitudinal axis on the guide instrument, which could lead to a change in position thereof for a rotation of the actuator.
  • a chisel guide is provided on the implant body. This can serve for introducing a chisel or another machining tool with which a vertebral body can be processed, in particular partially resected.
  • a particularly simple structure of the guide instrument results when the bit guide comprises at least one guide groove and when the at least one guide groove is arranged in one of the two contact surfaces extending parallel or substantially parallel to the longitudinal axis.
  • a machining tool such as a chisel, can thus be easily guided in the guide groove to resect a portion of a vertebral body to form a recess for receiving a fin-like protrusion on an intervertebral implant.
  • Optimum guidance over as long a distance as possible can be achieved if at least part of the bit guide protrudes on the proximal side of the implant body.
  • the proximal protruding part can simultaneously serve as a stop for the machining tool when it is moved in the chisel guide relative to the implant body.
  • bit guide in each case comprises a longitudinal groove on each contact surface.
  • the at least one stop on the implant body is mounted displaceably parallel or substantially parallel to the longitudinal axis. This makes it possible to change a position of the implant body relative to the vertebrae arranged adjacent to the intervertebral space parallel or substantially parallel to the longitudinal axis.
  • a drive mechanism for moving the at least one stop, and if the drive mechanism is arranged on the shaft or on the implant body and designed such that the at least one stop results from a movement of the power transmission member is movable.
  • the drive mechanism may be provided so that the stop is movable as a result of translational and / or rotational movement of the force transmission member. The drive mechanism thus makes it possible to move the stop only by moving the power transmission member, for example via the actuator.
  • a particularly simple design of the guide instrument results when the drive mechanism comprises a spindle drive for moving the at least one stop.
  • the spindle drive comprises a parallel or substantially parallel to the longitudinal axis on the implant body slidably mounted bearing carriage which carries the at least one stop, and a rotatably mounted about a parallel or substantially parallel to the longitudinal axis of rotation axis mounted threaded spindle, the one to a Having on the bearing carriage provided internal thread corresponding external thread, and when the threaded spindle is connected to the power transmission member or connectable.
  • a spindle drive constructed in this way makes it possible to set the threaded spindle in rotation due to a rotation of the force transmission member and thereby to effect a movement of the bearing slide parallel or substantially parallel to the longitudinal axis. As a result, the at least one stop can be moved in the desired manner.
  • the at least one stop is transverse to the longitudinal axis of a proximal end of the bearing carriage. In this way, it is possible for the stop to come into contact with the vertebral bodies adjacent to the intervertebral space and thus limit an insertion depth of the implant body into the intervertebral space.
  • the drive mechanism has a force transmission member receptacle into which a distal end of the force transmission member is inserted in a form-fitting manner. This also makes it easier to produce the instrument, in particular to assemble and clean.
  • the at least one stop it would be possible for the at least one stop to be mounted in the distal direction pointing away from the implant body. However, insertion of the implant body into the intervertebral space is then made more difficult. Conveniently, therefore, the at least one stop is mounted in the proximal direction pointing away from the implant body. As a result, the implant body can be pushed into the intervertebral space until the at least one abutment abuts the vertebral bodies adjacent to the intervertebral space.
  • the construction of the guide instrument is particularly simple if it is mirror-symmetrical to a mirror plane containing the longitudinal axis is. For example, it may also be formed symmetrically with respect to two mutually perpendicular mirror planes.
  • a set of surgical guide instruments for a surgical machining tool with an implant body for insertion into an intervertebral space between adjacent vertebral bodies of a human or animal spine, with a shaft and with a stop device for limiting an insertion depth of the implant body into the disc space, wherein the shaft has a distal end and a proximal end, the implant body defining two abutment surfaces engageable with the adjacent vertebral bodies and disposed at the distal end of the shaft, the set comprising two or more of the above-described guide instruments, and wherein the two or more guide instruments are different have large and / or differently shaped implant body.
  • the implant body is chosen in particular such that it fills the intervertebral space such that a spacing of the adjacent vertebral bodies during the surgical procedure corresponds to their original spacing, it is favorable if the implant bodies have different thicknesses and / or different angles of inclination between the abutment surfaces , As a result, further damage to the spine, in particular the vertebrae adjacent to the intervertebral space, is avoided.
  • a surgical instrumentation comprising at least one surgical machining tool, in particular a chisel, and at least one surgical guide instrument for the at least one surgical machining tool with an implant body for insertion into an intervertebral space between adjacent vertebral bodies of a human or animal spine , with a shaft and with an abutment device for limiting an insertion depth of the guide instrument into the intervertebral space, wherein the shaft has a distal and a proximal end, wherein the implant body defines two abutment surfaces which can be applied to the adjacent vertebral bodies and is arranged at the distal end of the shaft the stop device has at least one stop movably mounted on the distal end of the shaft or on the implant body, which stop has a transversely or substantially transversely to At least one of the abutment surfaces has a stop surface pointing in the distal direction, wherein the at least one surgical guide instrument is one of the guide instruments described above or one of the sets
  • the instrumentation according to the invention is outstandingly suitable for providing vertebral bodies with receptacles into which a protrusion on an intervertebral implant can dip.
  • the processing tool can be inserted too deep in the anterior / posterior direction into the intervertebral space.
  • the at least one machining tool is a milling tool with which a groove or a recess can be milled into a vertebral body.
  • the at least one machining tool is a single or a double bit. This allows a groove to drive easily into the respective vertebral body.
  • the at least one machining tool has a hollow tool shank, at the distal end of which at least one tool cutting edge is arranged, and when the shank of the guide instrument can be inserted into the tool shank.
  • the grip part can be separated from the shaft, after insertion of the implant body into the intervertebral space, for example, the grip part can be removed and the machining tool with its tool shaft can be advanced over the shaft of the guide instrument.
  • the processing tool is additionally guided on the management instrument.
  • an intervertebral space for inserting an intervertebral implant with two adjacent to the intervertebral space vertebral bodies adjacent vertebral body of a human or animal spine, substantially away from each other facing implant abutment surfaces, which at least one transverse or have a substantially fin-like protrusion projecting transversely from at least one implant abutment surface, in which the intervertebral space is cleared, in which a surgical guide instrument with an implant body, a guide for a machining tool and a stop device comprising at least one stop is used, the at least one stop so is set that the implant body can be inserted only minimally deep into the intervertebral space, the implant Kö is inserted into the intervertebral space until the at least one stop abuts the adjacent vertebral bodies, wherein the at least one stop is adjusted in dependence on a desired tool depth relative to the implant body and the implant body is driven further into the intervertebral space
  • the method according to the invention ensures that the depression is incorporated into at least one vertebral body in such a way that, in addition, damage to the vertebral body and also further injury to the spinal column, for example the spinal canal, are avoided.
  • a chisel can be used as a machining tool, which is guided in the guide and with which the depression is hammered into the vertebral body.
  • one of the guiding instruments described above is used as a management instrument. Carrying out the method with such a guiding instrument has the advantage that unintended injury to the spine due to the surgical procedure is avoided.
  • the at least one stop is adjusted under X-ray control. This ensures that neither the implant body nor the guided in the guide machining tool can injure the spine in an undesirable manner.
  • a guide instrument is selected with an implant body, and when a height of the implant body and an angle between the implant abutment surfaces of the implant body correspond to a height and angle of an implant to be implanted.
  • An operator can, if it is clear which implant he wants to use in the intervertebral space, select the appropriate management tool, which has the particular advantage that he can work with the machining tool without further reflection, the depression in the respective vertebral body and not fear, to injure the spine in an undesirable manner.
  • FIG. 1 shows a surgical guide instrument, generally designated by the reference numeral 10, which essentially comprises two parts comprises, namely a shaft portion 12 and a handle portion 14 which are releasably connectable with each other.
  • the shaft part 12 comprises an elongated hollow shaft 18 defining a longitudinal axis 16 which is provided adjacent to a proximal end 20 with two diametrically opposed flats 22.
  • an implant body 24 is arranged, which is formed substantially cuboid. It comprises two oppositely facing abutment surfaces, which are inclined relative to each other by an inclination angle 28. Depending on the intended use of the guide instrument 10, the angle of inclination 28 may assume values in a range of 0 ° to 30 °.
  • the implant body 24 is constructed in two parts and comprises a front part 30 and a rear part 32, wherein the rear part 32 is formed substantially T-shaped.
  • the rear portion 32 includes a central body 34 that extends substantially parallel to the longitudinal axis 16, and two laterally projecting side bodies 36 at a distal end that are flush with a proximal end surface of the front portion 30.
  • the side members 36 are provided with parallel to the longitudinal axis 16 extending bores 38 which are coaxially provided with an internal thread 40 holes 42 aligned on the front part 30.
  • an internal thread 40 holes 42 aligned on the front part 30.
  • the central body 34 is provided coaxially with the longitudinal axis 16 with a longitudinal bore 48, which tapers in one step at approximately half the length of the central body 34 and the proximal side forms a shaft receptacle 50, in which the distal End 52 of the shaft inserted and fixed to the center body 34, for example by screwing, welding or gluing.
  • the front part 30 is provided with a substantially parallelepiped-shaped recess 54, which is open in the proximal direction but is closed by the rear part 32.
  • the recess 54 is further provided transversely to the longitudinal axis 16 with two windows in the form of elongated holes 56.
  • the recess 54 serves for receiving and rotatable mounting of a coaxial with the longitudinal axis 16 between a distal boundary of the recess 54 and the distal end of the rear portion 32 arranged threaded spindle 58, in which a proximal open in the direction open réelleachtkant 60 is formed, which forms a shaft receiving.
  • a bearing carriage 62 is mounted on the threaded spindle 58, which comprises a transversely to the longitudinal axis 16 extending cross member 64 which is provided with a coaxial with the longitudinal axis 16 extending and with an external thread of the threaded spindle 58 corresponding internal thread 66.
  • Parallel to the longitudinal axis 16 are provided on the cross member 64 symmetrical to these holes 68, inserted into the guide rods 70 and fixedly connected to the cross member 64.
  • two guide holes 72 are provided on the side members 36, which are penetrated by the guide rods 70.
  • Proximal ends of the guide rods 70 terminate in a cube-shaped guide body 74 whose edge length is greater than a diameter of the guide rods 70.
  • Transverse to the longitudinal axis 16 and substantially transverse to the abutment surfaces 26 are of each guide body 74 two stops forming stop pin 76 from whose free ends are hemispherically rounded and their distal direction facing side surfaces stop surfaces 77 form.
  • a force transmitting member forming drive shaft 82 is provided, which passes through the shaft 18 and is provided at its distal end with a réelleachtkant 60 corresponding octagon 84 which is coming from the proximal ago in the réelleachtkant 60 form-fitting inserted.
  • a proximal end of the drive shaft 82 is shaped in the form of a hex 86.
  • the handle part 14 comprises an elongate, ergonomically shaped handle 88, to which a coupling housing 90 connects at the distal end.
  • a coupling housing 90 connects at the distal end.
  • On the housing 90 is rotatably mounted about the longitudinal axis 16, a drive wheel 92 which forms an actuator. It is provided on an outer side with a flat toothing, which facilitates actuation of the drive wheel 92.
  • the drive wheel 92 is provided with a hexagon socket, which is formed corresponding to the hexagon 86, so that it can be positively inserted through the drive wheel 92.
  • the drive wheel 92 on the distal side an annular flange 94 which dips into a corresponding, on the clutch housing 90 in the proximal direction open annular groove 96 and is guided in this, so that the drive wheel 92 is rotatably mounted about the longitudinal axis 16 on the clutch housing 90.
  • a square frame 98 is slidably mounted transversely to the longitudinal axis, namely, it is supported on one side of the housing 90 via a coil spring 100 and is connected on an opposite side with a push button 102 which in a Recess 104 of the coupling housing 90 is guided.
  • the coil spring 100 By the coil spring 100, the frame 98 is pressed in the direction of the push button 102, which abuts in a basic position on the clutch housing 90.
  • the flats 22 and the frame 98 form connecting members of a connecting device, in the form of a latching connection.
  • the flats 22 form locking members in the form of locking recesses and the frame 98 forms a locking member in the form of a resiliently biased on the handle portion 14 latching latch.
  • a circular opening 106 is provided on the coupling housing 90, whose diameter is selected corresponding to an outer diameter of the shaft 18. Further, transverse slots 108 are provided on the clutch housing 90 through which a portion of the drive gear 92 protrudes from the clutch housing 90.
  • the drive shaft 82 projecting from the shaft 18 on the proximal side is first pushed through the opening 106, through the frame 98 and through the drive wheel 92.
  • the proximal end of the shaft 18 is pushed through the opening 106 and the frame 98.
  • the frame 98 slides on the end 20 of the shaft 18 and is moved against the spring force of the coil spring 100 in the direction of this.
  • the coil spring 100 presses the frame 98 in the direction of the shaft 18 and thus also the push button 102 against the clutch housing 90. In this way, the shaft 18 and the drive shaft 82 are axially secured to the handle portion 14.
  • Two longitudinal grooves 110 are provided in the abutment surfaces 26 on the implant body 24 and extend parallel to the longitudinal axis 16. A distal end of the longitudinal groove 110 terminates at a distal end of the front portion 30, and a proximal end of the longitudinal groove 110 terminates at a proximal end of the central body 34.
  • the longitudinal grooves 110 form guide grooves for a surgical machining tool, such as a surgical chisel 112.
  • the guidance instrument 110 may be part of a set of guidance instruments.
  • a set may comprise, for example, a grip part 14 and a plurality of shaft parts 12.
  • the shaft parts 12 preferably differ in shape and size of the implant body 24, in particular these implant bodies 24 have different distances between the contact surfaces 26 from each other and different angles of inclination 28.
  • the guide instrument 10 can also be part of a surgical instrument, which in particular comprises at least one bit 112.
  • the bit 112 preferably includes a hollow shaft 116 which, after releasing the handle portion 14 from the shaft portion 12, can be slid over the shaft 18 in the distal direction.
  • a two-part cutting edge 118 is arranged, so that a so-called double bit is formed overall.
  • the cutting edge 118 is formed so that its width corresponds to a width of the longitudinal grooves 110 and also a distance between the two cutting edges forming the cutting edge 118 from each other a distance of groove bottoms 120 of the Longitudinal grooves 110 transverse to the longitudinal axis 16 corresponds.
  • the bit 112 may comprise a blade guard 122 mounted on the shaft 116, which in a basic position is resiliently held above the cutting edge 118 and can be retracted in the proximal direction against the force of a spring, not shown.
  • the shaft part 12 is connected to the handle part 14 in the manner described above.
  • the drive wheel 92 By rotating the drive wheel 92, the drive shaft 82 is set in rotation, until the bearing carriage 62 is brought into its most distal position and the guide body 74 abut against the side members 36.
  • the stop pins 76 now take their most distal position with respect to the shaft 18 a.
  • the implant body 24 is inserted through an entrance into a human or animal body and into an intervertebral space 124 between adjacent vertebral bodies 126 of a spinal column 128.
  • the shaft part 12 is thereby selected such that the implant body 24 corresponds to an implant to be implanted later in the intervertebral space 124 insofar as the spacing of the abutment surfaces 26 and an inclination thereof coincide relative to one another.
  • the implant body 24 is inserted into the intervertebral space 124 until the stop pins 76 projecting beyond the abutment surfaces 26 strike against the vertebral bodies 126. For example, under X-ray control, an operator can now determine whether the implant body 24 has been advanced far enough into the intervertebral space 124.
  • the drive shaft 82 is set in rotation again, but now in the opposite direction as in preparation of the guide instrument 10 to move the guide body 74 away from the side members 36.
  • the stop pins 76 are so in the proximal Direction and away from the implant body 24, and just as far as the implant body 24 may be further inserted into the intervertebral space 124. After adjusting the stop pin 76 of the implant body 24 is further advanced in the intervertebral space 124 until the stop pin 76 again abut the vertebral bodies 126. This adjustment process is continued until the implant body 24 assumes the desired position in the intervertebral space 124.
  • the handle portion 14 is separated from the shaft portion 12 by pressing the push button 102, the coil spring 100 is slightly compressed, so that the frame 98, the flattening 22 releases and the shaft 18 can be pulled out of the coupling housing 90 in the distal direction.
  • the chisel 112 is pushed with the cutting edge 118 in the desired shape and size with its shank 116 over the shaft 18.
  • Protrusions 130 projecting transversely on the cutting edge 118 form stops which prevent the cutting edge 118 from being driven too far in the distal direction. It is designed so that it can abut the stop pin 76 or alternatively also at the proximal end of the central body 34.
  • the guide instrument 10 and the stop pin 76 movably mounted thereon prevent the bit 112 from being driven too deep into the intervertebral space 124, resulting in unnecessary partial resection of the vertebral bodies 126 and, in the worst case, even injury to the nerves in the spinal canal would mean.
  • the bit 112 is first removed from the shaft part 12, then the grip part 14 is reconnected to the shaft part 12 and then the guide instrument 10 is removed from the body.
  • the guide instrument 10 as well as the entire instrumentation 114 are made of materials that are steam sterilizable.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Transplantation (AREA)
  • Dentistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP06123897A 2005-11-24 2006-11-11 Système de guidage pour instrument chirurgical Withdrawn EP1790298A1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE102005056824A DE102005056824A1 (de) 2005-11-24 2005-11-24 Chirurgisches Führungsinstrument

Publications (1)

Publication Number Publication Date
EP1790298A1 true EP1790298A1 (fr) 2007-05-30

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ID=37734386

Family Applications (1)

Application Number Title Priority Date Filing Date
EP06123897A Withdrawn EP1790298A1 (fr) 2005-11-24 2006-11-11 Système de guidage pour instrument chirurgical

Country Status (3)

Country Link
US (1) US7749271B2 (fr)
EP (1) EP1790298A1 (fr)
DE (1) DE102005056824A1 (fr)

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US8287572B2 (en) 2009-02-11 2012-10-16 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9033993B2 (en) 2009-11-03 2015-05-19 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9254130B2 (en) 2011-11-01 2016-02-09 Hyun Bae Blade anchor systems for bone fusion
US9480511B2 (en) 2009-12-17 2016-11-01 Engage Medical Holdings, Llc Blade fixation for ankle fusion and arthroplasty
US9925051B2 (en) 2010-12-16 2018-03-27 Engage Medical Holdings, Llc Arthroplasty systems and methods
US10182923B2 (en) 2015-01-14 2019-01-22 Stryker European Holdings I, Llc Spinal implant with porous and solid surfaces
US10238382B2 (en) 2012-03-26 2019-03-26 Engage Medical Holdings, Llc Blade anchor for foot and ankle
US10456272B2 (en) 2017-03-03 2019-10-29 Engage Uni Llc Unicompartmental knee arthroplasty
US10537666B2 (en) 2015-05-18 2020-01-21 Stryker European Holdings I, Llc Partially resorbable implants and methods
US10835388B2 (en) 2017-09-20 2020-11-17 Stryker European Operations Holdings Llc Spinal implants
US11266510B2 (en) 2015-01-14 2022-03-08 Stryker European Operations Holdings Llc Spinal implant with fluid delivery capabilities

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US20080027548A9 (en) 2002-04-12 2008-01-31 Ferree Bret A Spacerless artificial disc replacements
US6908484B2 (en) 2003-03-06 2005-06-21 Spinecore, Inc. Cervical disc replacement
US7491204B2 (en) 2003-04-28 2009-02-17 Spine Solutions, Inc. Instruments and method for preparing an intervertebral space for receiving an artificial disc implant
US7763024B2 (en) * 2004-09-23 2010-07-27 Spine Solutions, Inc. Adjustable cutting of cutout in vertebral bone
US20070123904A1 (en) * 2005-10-31 2007-05-31 Depuy Spine, Inc. Distraction instrument and method for distracting an intervertebral site
CN101547656A (zh) * 2006-07-31 2009-09-30 辛迪思有限责任公司 钻进/碾磨导向器和龙骨切削准备系统
US8591587B2 (en) 2007-10-30 2013-11-26 Aesculap Implant Systems, Llc Vertebral body replacement device and method for use to maintain a space between two vertebral bodies within a spine
US8142441B2 (en) * 2008-10-16 2012-03-27 Aesculap Implant Systems, Llc Surgical instrument and method of use for inserting an implant between two bones
US9095450B2 (en) * 2008-12-24 2015-08-04 DePuy Syntheses Products, Inc. Insertion instrument for anteriorly inserting intervertebral spinal implants
CA2758712A1 (fr) * 2009-04-15 2010-10-21 Marc Reichen Ensemble implant d'essai
US8469959B2 (en) * 2010-02-11 2013-06-25 Warsaw Orthopedic, Inc. Bone preparation device
WO2011117736A2 (fr) * 2010-03-22 2011-09-29 Scitech Produtos Medicos Ltda Endoprothèse et système de libération permettant de libérer l'endoprothèse dans le vaisseau d'un patient
US9615856B2 (en) 2011-11-01 2017-04-11 Imds Llc Sacroiliac fusion cage
EP3195833B1 (fr) 2016-01-19 2022-01-12 K2M, Inc. Instruments chirurgicaux
WO2018020581A1 (fr) * 2016-07-26 2018-02-01 オリンパステルモバイオマテリアル株式会社 Instrument chirurgical de coupe d'os
US10390955B2 (en) 2016-09-22 2019-08-27 Engage Medical Holdings, Llc Bone implants
US11540928B2 (en) 2017-03-03 2023-01-03 Engage Uni Llc Unicompartmental knee arthroplasty
EP3381412B1 (fr) 2017-03-29 2023-10-18 Stryker European Operations Holdings LLC Système d'implant rachidien
US10888435B2 (en) 2017-10-05 2021-01-12 Spine Wave, Inc. Modular inserter for anterior cervical cage
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Cited By (28)

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Publication number Priority date Publication date Assignee Title
US9138275B2 (en) 2009-02-11 2015-09-22 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US8349015B2 (en) 2009-02-11 2013-01-08 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US8821555B2 (en) 2009-02-11 2014-09-02 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US10271959B2 (en) 2009-02-11 2019-04-30 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9138276B2 (en) 2009-02-11 2015-09-22 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US8287572B2 (en) 2009-02-11 2012-10-16 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9788968B2 (en) 2009-02-11 2017-10-17 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US10687964B2 (en) 2009-08-10 2020-06-23 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
WO2011019699A3 (fr) * 2009-08-10 2011-04-07 Howmedica Osteonics Corp Implant intervertébral avec fixation intégrée
US9700434B2 (en) 2009-08-10 2017-07-11 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9033993B2 (en) 2009-11-03 2015-05-19 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9861498B2 (en) 2009-11-03 2018-01-09 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US10799370B2 (en) 2009-11-03 2020-10-13 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US11628071B2 (en) 2009-11-03 2023-04-18 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US10238426B2 (en) 2009-12-17 2019-03-26 Engage Medical Holdings, Llc Blade fixation for ankle fusion and arthroplasty
US9480511B2 (en) 2009-12-17 2016-11-01 Engage Medical Holdings, Llc Blade fixation for ankle fusion and arthroplasty
US9925051B2 (en) 2010-12-16 2018-03-27 Engage Medical Holdings, Llc Arthroplasty systems and methods
US10245090B2 (en) 2011-11-01 2019-04-02 Engage Medical Holdings, Llc Blade anchor systems for bone fusion
US9254130B2 (en) 2011-11-01 2016-02-09 Hyun Bae Blade anchor systems for bone fusion
US10238382B2 (en) 2012-03-26 2019-03-26 Engage Medical Holdings, Llc Blade anchor for foot and ankle
US11266510B2 (en) 2015-01-14 2022-03-08 Stryker European Operations Holdings Llc Spinal implant with fluid delivery capabilities
US11000386B2 (en) 2015-01-14 2021-05-11 Stryker European Holdings I, Llc Spinal implant with porous and solid surfaces
US10182923B2 (en) 2015-01-14 2019-01-22 Stryker European Holdings I, Llc Spinal implant with porous and solid surfaces
US10537666B2 (en) 2015-05-18 2020-01-21 Stryker European Holdings I, Llc Partially resorbable implants and methods
US11623027B2 (en) 2015-05-18 2023-04-11 Stryker European Operations Holdings Llc Partially resorbable implants and methods
US10456272B2 (en) 2017-03-03 2019-10-29 Engage Uni Llc Unicompartmental knee arthroplasty
US10835388B2 (en) 2017-09-20 2020-11-17 Stryker European Operations Holdings Llc Spinal implants
US11622867B2 (en) 2017-09-20 2023-04-11 Stryker European Operations Holdings Llc Spinal implants

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Publication number Publication date
US20070118145A1 (en) 2007-05-24
DE102005056824A1 (de) 2007-05-31
US7749271B2 (en) 2010-07-06

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